Provider Demographics
NPI:1053749218
Name:THE LEARNING AND LANGUAGE CENTER AT CALICO
Entity type:Organization
Organization Name:THE LEARNING AND LANGUAGE CENTER AT CALICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGILSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-321-4898
Mailing Address - Street 1:1650 N HILTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1734
Mailing Address - Country:US
Mailing Address - Phone:208-321-4898
Mailing Address - Fax:208-321-4859
Practice Address - Street 1:1650 N HILTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1734
Practice Address - Country:US
Practice Address - Phone:208-321-4898
Practice Address - Fax:208-321-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1396235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty